Surgical Department, Haraldsplass Deaconess Hospital, Pb 6165, 5152, Bergen, Norway.
University of Bergen, Bergen, Norway.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):707-713. doi: 10.1007/s00167-019-05395-5. Epub 2019 Feb 7.
The current study investigated the distribution of hamstrings graft size and body mass index and any potential effect on the risk of revision surgery in a large prospective cohort of patients undergoing ACL reconstruction. More specifically, the aim of the study was to investigate whether larger graft size or smaller BMI would decrease the risk of revision after ACL reconstruction.
A total of 4029 patients, prospectively registered in the Norwegian Knee Ligament Registry, were included in the study. Univariate Kaplan-Meier survival analyses (with log-rank tests) and the Cox proportional hazard (PH) regression model were applied to compare risk of revision between groups of patients. Mutual adjustment for gender, age, activity at the time of injury and fixation method of the graft was performed.
Graft sizes spanned from 5.5 to 11.0 mm and the median of 8.0 mm was reported in 42% of patients in the cohort. BMI was reported from 15 to 57 with a median of 25. 46% of patients were classified as overweight (WHO standards), while 23% of patients were obese. At a median of 2.5 years after surgery, 150 patients had undergone revision surgery. Although certain effects were seen in the unadjusted analyses, neither graft size (diameter) nor patient BMI did affect the risk of undergoing revision surgery in the adjusted analyses.
Graft size and BMI was not found to be independent risk factors for undergoing ACL revision surgery. In contrast to other studies, graft size of 8 mm or larger did not have a better outcome than smaller graft sizes. A relatively large group of overweight patients undergoing ACL surgery reflects the general increase in weight seen in Western societies. Although the current study differs from previous findings, it might indicate that graft diameter is less important than previously stated.
Cohort study, II.
本研究通过对大量接受 ACL 重建的前瞻性患者队列，调查腘绳肌腱移植物大小和体重指数的分布，以及其对翻修手术风险的潜在影响。更具体地说，研究的目的是调查更大的移植物大小或更小的 BMI 是否会降低 ACL 重建后的翻修风险。
共纳入挪威膝关节韧带登记处前瞻性注册的 4029 例患者。采用单变量 Kaplan-Meier 生存分析（对数秩检验）和 Cox 比例风险（PH）回归模型比较各组患者的翻修风险。对性别、受伤时的年龄、活动水平和移植物固定方法进行了相互调整。
移植物大小范围为 5.5 至 11.0mm，队列中有 42%的患者报告中位数为 8.0mm。体重指数报告范围为 15 至 57，中位数为 25。46%的患者被归类为超重（WHO 标准），而 23%的患者肥胖。手术后中位数为 2.5 年，有 150 例患者接受了翻修手术。尽管在未调整分析中观察到某些影响，但在调整分析中，移植物大小（直径）或患者 BMI 均不影响接受 ACL 翻修手术的风险。
移植物大小和 BMI 不是接受 ACL 翻修手术的独立危险因素。与其他研究不同，8mm 或更大的移植物大小并没有比较小的移植物大小更好的结果。接受 ACL 手术的超重患者相对较多，反映了西方社会普遍体重增加的情况。尽管本研究与以前的发现不同，但它可能表明移植物直径比以前认为的不那么重要。
队列研究，II 级。
